Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 48724 | MN |
NPI | 1043241292 |
---|---|
Provider Name | Panagiotis H Panagiotakis |
First Address | Minneapolis, MN 55414-0909 |
Second Address | Bloomington, MN 55437-3126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 06/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I54824 | (02) | MN |